keywords:
Bookmark and Share



Front Back
The phenomen of spontaneous resolution of RCC thought to represent
-T-or B-cell mediated antitumor immunity
The true incidence of spontaneous regression of RCC is
-less than 1 %
Interferon resonse rate in different trials
-16-26%
-10-15%
Durabel complete rsponse after treatment with interferone
-less tha 2%
Interleukin-2 and response rates in several trials
-15-20%
The rate of complete regression after treatment with IL-2
-7-9%
Doses of IL-2
-600.000-720.000 IU/kg every 8 hours
-as tolerated to a maximum of 15 doses
Toxicity of IL-2
-vascular leak syndrome
-hypotension
-third space fluid retention
-respiratory compromise
-multiorgan damage
Combination of IL-2 and interferone-alfa
-higher response rate
-no significant difference in survival
-higher toxicity
Currently thrapy with IL-2
-reasonable option in the initial therapy of carefully selected patients with met ccRCC
Allogenic Hematopoetic Stem Cell Transplantation
-experimental approach in the management of RCC
mTOR influenses on
-HIF
-and HIF is upregulated by mTOR
Bevacizumab (Antibody) targets
-VEGF
Axitinib
Pazopanib
AV-951 (Tivozanib) target
-VEGF
Sunitinib
Sorafenib target
-VEGF
-PDGF
Bevacizumab
-humanized monoclonal antibody against VEGF-A
Bevacizumab in the initial therapy for met ccRCC
-is not widely used as a single agent
-but may have a role in pts failed standard therapy with first line VEGFR antagonisis
-alone or in cobination with interferone
Side effects of bevacizumab combination therapy
-grade 3 adverse effects
-HTN
-fatigue
-anorexia
-asthenia
Sorafenib
-oral receptor kinase inhibitor with activity against VEGFR2, PDGF
Side effects of sorafenib
-hypertesion
-fatigue
-rash
-hand-foot syndrome
-diarrhea
Surafenibin the first line setting
-infrequently used
Sunitinib
-is currently the most used oral VEGFR kinase inhibitor in the initial treatment of met ccRCC
-potent inhibitor of VEGFR2, PDGFR
Dose administration of sunitinib
-50 mg/day
-4 weeks of a 6 week cycle
Overall survival rate in treatment of sunitinib
-30-40%
Side effects of sunitinib
-GI effects (diarrhea)
-dermatologic manifestations (rash and hand-foot syndrome)
-fatigue
-asthenia
-hypertension
-bone marrow suppression
-decline in lt. ventricular injection fraction
-hypothyroidism
Axitinib
-oral TKI of VEGFR1, VEFR2, VEGFR3
Adverse effects of axitinib
-diarrhea
-fatigue
-hypertension
-grade 3-4
-but amenable to medical management
Pazopanib
-hemorrhagic diathesis,
-thrombocytopenia, nausea, vomiting, abdominal pain,
-increased serum aspartate aminotransferase, increased serum alanine aminotransferase, decreased serum glucose, increased serum bilirubin, 
- fatigue, hypertension, diarrhea, neutropenia, leukopenia, and anorexia.
Tivazonib (AV-951)
-INVESTIGATIONAL AGENT
 Mammalian Target of Rapamycin
-intracellular component
-plays a role in regulating translation and stability of HIF-1alfa
mTOR agents
-temserolimus
-everolimus
Temserolimus is agent of choice for pts with
-poor risk features
Adverse effects of temserolimus
-mucositis
-fatigue
-rash
-hyperglycemia
-hypophosphotemia
-pulmonary complications
-amenabe to medical treatment
Doses of temserolimus
-IV 25 mg per week
-dose independent
Everolimus
-an orally bioavailable inhibitor of mTOR
Non clear cell RCC and  treatment
-there is no standard approach of proven efficacy
x of y cards